A problem occurs when a person is attempting to make a health care decision, such as, for example selecting a medical insurance (or even life insurance) plan suitable for that person or for that person's family. Different plans have different deductibles for different procedures. Different plans also have different healthcare providers characterized as “in-network” or “out of network” providers. Since the “proper,” i.e. lowest cost plan that meets the individual's and/or family's needs will ultimately depend upon what medical services that person (or family) will require over the life of the plan and since that information is, by definition, not known at the time of plan selection, the solution is usually a “best estimate” guess. With something as crucial to a person's physical and financial health as medical insurance, the existing system for selection of a proper plan leaves a great deal to be desired.
One example of the problem arises when a family tried to decide which medical management plan to sign up for at work. Assume both the husband and the wife each have several options. Also assume that the husband is currently seeing Doctor A for a specific illness. Also assume that the wife is of child-bearing years but they already have two children. In our example, the husband's plan is less expensive than the wife's plan and includes Doctor A. If this family were to accept the wife's plan they would pay more per month and if the husband were to continue using Doctor A he would not be reimbursed the full amount because Dr. A is not on the “in-network” list of the wife's plan. Based on the available facts, it appears that the husband's plan should be selected.
However, this analysis did not take into account the reimbursement for medications for each plan, nor did it take into account the medical costs for the two children. Also not taken into account is the likelihood of a long-term illness to a family member where medication costs, hospital reimbursements, perhaps home-care costs and certainly maximum limits could drastically affect the overall cost of medical assistance.
Also not taken into account is the fact that different types of procedures require different expertise. Thus, a particular group of medical providers may yield statistically better results than another group for treatment of a specific ailment. Thus, deciding upon a healthcare plan, or even upon a course of healthcare treatment, requires more information than is currently available to a potential healthcare purchaser.